Assessing and Treating Eating Disorders

This article explores eating disorders, including their definitions, symptoms, diagnostic criteria, and common treatment approaches.

Overview of eating disorders

Eating disorders are a group of mental health conditions characterised by a persistent disturbance in an individual’s eating behaviour and attitudes towards food (related reading: How Nutrition Impacts Mental Health). These disorders often have serious physical and psychological consequences and can have a significant impact on an individual’s quality of life.

There are several types of eating disorders, including:

• Anorexia nervosa: This is a serious and potentially life-threatening disorder characterised by an intense fear of gaining weight, a distorted body image, and a persistent restriction of caloric intake. Individuals with anorexia nervosa often weigh themselves repeatedly and are extremely afraid of gaining weight.
• Bulimia nervosa: This disorder is characterised by recurrent episodes of binge eating, during which the individual consumes large amounts of food in a short period of time, followed by purging behaviours such as self-induced vomiting, laxative abuse, or excessive exercise.
• Binge eating disorder: This disorder is characterised by recurrent episodes of binge eating, during which the individual consumes large amounts of food in a short period of time, accompanied by a feeling of lack of control over eating behaviour. Unlike bulimia nervosa, individuals with binge eating disorder do not engage in purging behaviours.
• Other specified feeding or eating disorders (OSFED): This category includes conditions that do not meet the full criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder, but still result in significant distress and impairment.

What are eating disorders?

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5-TR) defines eating disorders as a group of conditions characterised by persistent disturbances in eating behaviour and related thoughts, feelings, and behaviours. According to the DSM-5-TR, the following are the specific diagnostic criteria for eating disorders:

• Anorexia nervosa: The DSM-5-TR defines anorexia nervosa as a restriction of energy intake relative to needs leading to a significantly low body weight, intense fear of gaining weight, or persistent behaviour that interferes with weight gain, and an unduly influenced self-evaluation based on body weight or shape.
• Bulimia nervosa: The DSM-5-TR defines bulimia nervosa as recurrent episodes of binge eating characterised by eating, in a discrete period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances, and a feeling of a lack of control over eating during the episode. Additionally, the individual must engage in compensatory behaviours, such as fasting, purging (e.g., self-induced vomiting, abuse of laxatives, diuretics, or enemas), or excessive exercise, to prevent weight gain.
• Binge eating disorder: The DSM-5-TR defines binge eating disorder as recurrent episodes of binge eating characterised by eating, in a discrete period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances, and a feeling of a lack of control over eating during the episode. Unlike bulimia nervosa, the individual does not engage in compensatory behaviours to prevent weight gain.
• Other specified feeding or eating disorders (OSFED): This category includes conditions that meet some but not all of the criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder, and result in significant distress and impairment. Examples of OSFED include atypical anorexia nervosa (in which the individual has maintained a normal weight) and purging disorder (in which the individual engages in purging behaviours without binge eating).

It is important to note that the DSM-5-TR criteria provide a diagnostic framework for eating disorders and should not be used as the sole basis for making a diagnosis. A comprehensive evaluation, including a thorough medical and psychiatric history and physical examination, is necessary to make an accurate diagnosis.

What are the symptoms of eating disorders?

The symptoms of eating disorders vary depending on the specific disorder, but they often include disturbances in eating behaviour, body image, and self-esteem. Some common symptoms include:

Anorexia nervosa

• Restriction of caloric intake leading to significant weight loss
• Intense fear of gaining weight or becoming fat
• Distorted body image, persistent denial of the seriousness of low body weight
• Menstrual irregularities or the cessation of menstrual periods in females
• Fainting, fatigue, and weakness

Bulimia nervosa

• Recurrent episodes of binge eating, during which the individual consumes large amounts of food in a short period of time
• Purging behaviours such as self-induced vomiting, abuse of laxatives, diuretics, or enemas
• Compulsive exercising
• Binge eating followed by feelings of guilt and shame
• Electrolyte imbalances and dehydration

Binge eating disorder

• Recurrent episodes of binge eating, during which the individual consumes large amounts of food in a short period of time and experiences a feeling of a lack of control over eating
• Eating alone because of embarrassment about the amount of food being consumed
• Feelings of guilt, shame, and distress after binge eating episodes
• Weight fluctuations

Other specified feeding or eating disorders (OSFED)

• Behaviours and attitudes related to eating that cause significant distress and impairment, but do not meet the full criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder.

Those experiencing any of the symptoms of an eating disorder should seek professional help. Eating disorders can have serious physical and psychological consequences and early intervention is crucial for a successful recovery.

How to diagnose eating disorders

Eating disorders are diagnosed through a comprehensive evaluation that includes:

• Medical history: The clinician will ask questions about the individual’s eating habits, weight history, physical symptoms, and medical history.
• Psychological evaluation: The clinician will ask about the individual’s thoughts, feelings, and behaviours related to food, eating, and weight. They may also perform a mental health screening to rule out any co-occurring mental health conditions.
• Physical examination: A physical examination and laboratory tests will be performed to assess the individual’s overall health and determine the presence of any medical complications related to the eating disorder.
• Diagnostic criteria: The clinician will use the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5-TR, as noted above) to diagnose the eating disorder.

Note that the diagnosis of an eating disorder is complex and should only be made by a qualified mental health professional with expertise in the assessment and treatment of eating disorders. The clinician will also consider any additional information that may be relevant to the individual’s case, such as cultural, social, and family factors.

Common treatment approaches for eating disorders

The treatment of eating disorders typically involves a combination of medical and psychological approaches, tailored to meet the individual’s specific needs. Some common treatments for eating disorders include:

• Psychotherapy: Cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and family-based therapy (FBT) are among the most effective forms of psychotherapy for eating disorders. These therapies focus on changing the individual’s thoughts, behaviours, and attitudes related to food, eating, and weight.
• Medical care: Medical care is an important component of treatment for eating disorders, particularly for individuals with anorexia nervosa who may require close monitoring and management of medical complications. A healthcare provider will monitor the individual’s physical health and provide appropriate medical interventions as needed.
• Nutritional counselling: A registered dietitian can work with the individual to develop a balanced and nutritious meal plan and help them learn to eat in a healthy and normal way.
• Medications: Certain medications, such as anti-depressants and antipsychotics, may be prescribed to help manage the individual’s symptoms and improve their overall mental health.
• Hospitalisation: In severe cases of anorexia nervosa, hospitalisation may be necessary to stabilise the individual’s medical condition and provide a structured and safe environment for treatment.
• Support groups: Support groups can provide a supportive and understanding community for individuals with eating disorders and their families. They can also be an effective supplement to individual therapy.

It should be kept in mind that the treatment of eating disorders is a long-term process and requires a collaborative and comprehensive approach that involves the individual, their family, and a team of healthcare professionals. The treatment plan should be adjusted as needed to meet the individual’s changing needs and ensure their continued progress and recovery.

Key takeaways

• Eating disorders are a group of mental health conditions characterised by persistent disturbances in an individual’s eating behaviour and attitudes towards food.
• There are several types of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorders (OSFED).
• Eating disorders are diagnosed through a comprehensive evaluation that includes a medical history, psychological evaluation, physical examination, and diagnostic criteria.
• Treatment of eating disorders typically involves a combination of medical and psychological approaches, such as psychotherapy, medical care, nutritional counselling, medications, and support groups.
• Treatment of eating disorders is a long-term process that requires a collaborative and comprehensive approach.